Semi-inspired by this article by Jen Myers about keeping a Media List, I am going to try to do just that! Whenever I remember or can, I’m trying to write down things that I completed - so I won’t put a book on here if I am still in progress, etc. The idea is to have a big list at the end of the year of what I read/watched/listened to - which I think is useful to start to see how your life and view is impacted by what you are consuming. Of course, not included in this list are tons of tiny things that I read all the time without even thinking about it - about the news and the weather. But this is still a step and an encouragement for me to really spend my time with content that I enjoy.

It was about a year ago that I heard about CBD for the first time, from someone living in the States who recommended it for… seemingly just about everything. I was immediately curious but unsure. I heard that it was non-psychoactive (aka it won’t get you high like THC does) and my first thought when I heard that all these people were consuming the nonpsychoactive part of weed was to think that they were probably all being scammed into paying good money for the non-active part of weed. The useless part.

[A quick review for those of you who have never heard of it: CBD is one of several cannabinoids that are found in cannabis. Cannabinoids are compounds that act on the cannabinoids receptors (CB1 and CB2) that you already have in your nervous system. Your body produces its own cannabinoids, and when they’re produced by the body they’re called endocannabinoids. THC is one cannabinoid, and CBD (short for cannabidiol) is another - the two of them are the ones that are most bountiful in cannabis, but there are lots of others that are still being researched! ]

I stayed curious though, and on legalization day I looked on the Ontario Cannabis Store (ocs.ca) and saw that they were selling it, so I bought a bottle. I figured that if the government was selling it, it probably wasn’t just snake oil. I think when I bought it I had mostly heard that it was supposed to help with sleep and when I took it, it didn’t seem very helpful for sleep.

Then I started doing more research on this topic and it totally blew my mind. There is actually really amazing evidence that CBD can help with all sorts of things, from anxiety, to pain, to inflammation, and more! I’ll outline them below, but first:

A few things you should pay attention to when you’re looking at ‘evidence’ for CBD’s effects:

1. CBD can have opposite effects at high vs low doses

CBD exerts what is called a ‘biphasic’ effect, which means that the effect at a low dose and the effect at a high dose might be completely opposite one another! This seems to be the case for the research on sleep – generally speaking, CBD at lower doses promotes alertness and wakefulness, whereas at high doses (and boy, am I talking high – like for ONE of those doses you’d have to drink bottles and bottles of the $85 stuff they sell on OCS) it would have a sleep inducing effect.

2. Is the evidence only based on animal studies, or have they found an effect in humans too?

This is the difference between what the scientific community would call ‘preclinical’ vs ‘clinical’ studies. Whenever a substance is being tested for potential therapeutic effects, first preclinical studies are done on animals (I won’t comment here on the practice of testing on animals). If those go through and show that there is some evidence of a benefit and no really bad side effects. Then they move to clinical studies with humans. You can probably guess already that studies that show an effect in humans provide much stronger evidence than studies that show an effect in animals only.

3. Pay attention to dose sizes.

Lots of article that list the benefits of CBD seem kindof well researched (because they’ll cite studies). But if you look a little bit deeper at those studies, you’ll realize that the doses of CBD that they took to obtain those effects are huge - way bigger than you’d ever be able to take.

To give you some context, what I bought was (on the day of legalization) the least expensive high CBD:THC ratio oral product being sold. It’s a 30ml bottle of CBD oil (containing 25.7mg/mL of CBD and 1.2mg/mL of THC) for $83.35, by brand Aurora. Based on those values, the total amount in mg of CBD contained in one 30mL bottle would be 771mg.

Now for comparison, most of the studies on sleep (which were on rats!) used 40 mg CBD/kg body weight: that would be the equivalent of, for a 60kg person: 2400mg! You’d have to consume more than three whole bottles of the stuff I have to get that kind of dose! There are products that have those kinds of doses but they’re for medical users and not available for recreational sale. So the reality is that even if you have 100 journal articles all saying that CBD will help sleep – that doesn’t mean anything if they’re all talking about a 2000mg dose that you would never be able to take recreationally anyway!

So what areas does CBD have an effect on?

FYI - I’m not going to comment on all the uses of CBD for various diseases or conditions, such as epilepsy, arthritis, schizophrenia, and more. You can consult this article by Health Canada if you want a review of all the conditions that may be improved by cannabis consumption overall, but if you have a condition that you think could be improved by the use of cannabis, then you should talk to your doctor.

The effects I’ll present here are effects on issues that affect really significant percentages of the population of otherwise ‘well’ people.

Anti-inflammatory

Overall, CBD is an anti-inflammatory which is responsible for many of the beneficial effects of CBD. Anti-inflammatory agents have the potential to help a ton of health issues because so many health issues are essentially inflammation in one form or another.

Neuroprotective + Anti-oxidant

Anti-oxidants like CBD may have a neuroprotective effect. Antioxidant is such a buzzword but that doesn’t mean that they’re necessarily a panacea - some studies have even shown that high levels of antioxidants are correlated with higher mortality!

Anti-Anxiety

The one place where low doses of CBD have REALLY good evidence is anxiety. There is REALLY good evidence for this: multiple trials in humans of people receiving oral doses that aren’t crazy high (the highest dose that is known to still reduce anxiety is 600mg) and quite low doses can still have an effect. Interestingly, the research shows that CBD actually counteracts the anxiety-inducing effects of THC (yes, that’s correct – THC induces anxiety!).

Wakefulness/Alertness

Some studies show that CBD, in the lower doses that you might consume as a recreational user, improve wakefulness and alertness. Higher doses (really high!) Seem to show the opposite effect: they can help with sleep. However in this area, only a few studies have been done on humans, and different studies have shown inconsistent effects, so I wouldn’t count on this one overly!

Anti-Nausea

There is significant evidence that CBD helps with nausea. Interestingly, so does THC, but by a completely different mechanism!

Anti-Acne

This one is thanks to the anti-inflammatory effects of CBD. These studies are new and not in humans - they’re basically on skin cells grown in a test tube, so again, take this with a grain of salt until we hear more. Application would need to be topical.

CBD can counteract some of the effects of THC

It also counteracts other negative effects of THC, which means that if you already smoke or consume weed, you might want to think about trying a variety with a higher ratio of CBD next time instead of just assuming that the higher the THC, the better – you might find good results! In fact, you might want to pay more attention to the CBD and THC ratios than to whether it is an indica or a sativa: give a try at reading this interview with a doctor named Ethan Russo who argues that that distinction is basically made up!

How should you take it?

It is so hard to find information that actually tells you EVERYTHING that you want to know as a consumer – i.e. not just what the effects are but how much CBD you’d need to take in order to get that effect. Although this is definitely not a resource that is meant for us regular people and it is not exactly short, the best resource I found about cannabis overall was the outline for healthcare professionals that Health Canada provided, which is available here.

CBD can be consumed orally (usually in oils), inhaled (either smoked or vaporized), or applied topically. There are several other ways to administer it but those are the 3 most common since they’re pretty non-invasive and easy to acquire.

CBD has lower bioavailability when consumed orally than when inhaled. But if you’re inhaling your CBD, then I would highly encourage you to vaporize it instead of smoking it: the risk that come with smoking it is essentially the biggest health risk that comes with any cannabis consumption.

Topical application would be recommended only for effects that are localized to the skin: so for instance this study on acne specifically mentions that it would be difficult for an oral dose of CBD to have a high enough concentration to exert an effect all the way at the skin, so they mention that topical application would be necessary.

Is CBD safe?

One of the things that I wanted to know was: is CBD safe? And it turns out that the generally agreed upon answer is yes – CBD is safe, in fact it’s seen as being much safer than THC! But that doesn’t mean that everyone should take it.

CBD is not addictive

Just thought I would put that out there. Overall, cannabis is not a very addictive drug, but cannabis addiction does happen (there’s just arguments about what cannabis dependence really means). However dependence is associated with the THC content. There is absolutely no evidence of CBD being addictive. In fact, it is being investigated as a treatment for addiction to various other substances, including THC, alcohol, tobacco, and more.

Yes, CBD could interact with other medications you’re taking.

One thing that I was surprised to realize (maybe because of how we think about 'natural' products or medications) was that there DEFINITELY may be drug interactions to think about, for both THC and CBD. CBD affects an enzyme that is involved in the metabolism of 25% of all medications. If those enzymes are significantly affected by CBD, then you’re going to end up with WAYY higher levels of drugs in your system, because they’re not breaking down. That means that if you are taking or plan on taking CBD regularly, and you take other medications, you should talk to your doctor about it because you might actually need to lower your dose of your other meds. Otherwise you could get negative side effects from too-high doses of your regular medications (hopefully this is obvious: don’t just lower your meds based on what I’m saying here… TALK TO YOUR DOCTOR!). If you want to learn more about that, I found this set of slides by the D.C. government to be really helpful in explaining all this stuff about interactions and the bad stuff that no one really wants to hear about but that everybody really needs to know.

Pregnancy

If you’re pregnant, trying to get pregnant, or breastfeeding, Health Canada recommends avoiding the use of cannabis products. See here for a bit more information on this and how the endocannabinoid system plays a role in egg fertilization and pregnancy.

Will I get high?

Even though I had heard that CBD was non-psychoactive, I still felt a bit nervous! I took it for the first time on a night when I knew I didn’t have to go anywhere or teach. I was nervous in part because I saw this on the bottle:

1.2mg/mL THC

25.7 mg/mL CBD

Although it obviously seemed like there was less THC than CBD - I realistically didn’t have any idea of how many mg would get me high! For all I knew, that could be a lot of THC.

Well, I am here to solve your worries: I did not get high from it and you won’t either (if the ratios are similar to what is above). Because of the fact that CBD is known to counteract the effects of THC, if the ratio of CBD to THC is 1:1 or has higher levels of CBD than THC, you likely won’t feel much of a high.

Note: you still shouldn’t drive afterwards, just in case (especially if it’s your first time).

So should you take it?

Trick question! I don’t know. I can’t tell you whether you should take it or not. But I hope this gave you more information so that you can make a more informed decision on your own! Comment below though if you’ve tried CBD or if you’re curious or with any other comments!

P.S.

In case you’re wondering: what I bought was a bottle of CBD drops by brand Aurora from OCS. It’s now sold out, along with almost all the high CBD ratio oils/capsules, but you can check in to see what they have here.

In almost every week of my anatomy class at U of T, I find out something that absolutely surprises me, that I never would have guessed could possibly be true. We learned a few weeks ago about the types and composition of bones. There were a few cool things that I maybe sortof knew but didn’t really have a grasp on before, and some that I was totally shocked by!

Bones are ORGANS and can be classified by their shape as long, short, flat or irregular. But have you ever heard about this other category of bones called the sesamoid bones? I definitely hadn’t. Sesamoid bones are bones that are not present at birth and develop within a tendon in response to strain in that tendon. Most sesamoid bones are pretty tiny but the largest one is a bone that we are probably all familiar with: the patella (aka kneecap)!

When babies are born, they are patella-less (go find a baby and take a look at their knees!). As they start kicking their legs (before they have started walking) there starts to be friction experienced in the tendon that crosses in front of the knee joint. In response to the repeated experience of that tension, part of your tendon starts to turn into bone (well, first cartilege, then bone!). That bone continues to develop as you get larger and keep kicking your legs and crawling and then walking until eventually you end up with the patella you have right now.

FYI - I found this image online in many places but didn’t find a source for it anywhere! Please let me know if you know the owner or creator of this image.

This can technically happen anywhere in the body where there is a tendon that is subject to enough friction over a long enough period of time. So apparently cowboys sometimes develop a sesamoid bone on the inner knee as well from all the time in the saddle!

My knees have always been a bit of a point of sensitivity for me (literally and figuratively). I’ve always thought that my knees looked funny. And my knees have been a literal point of discomfort and sensitivity for me - I’ve been dealing with knee pain for a long time. I ended up stopping running when I was in university because, despite going to physio, I just couldn’t run regularly without experiencing knee pain in my everyday life.

Then about this time last year, I partially dislocated my kneecap after I slipped when stepping down from a chair after returning a hanging plant I had just watered to its place. It’s not the first time that has happened to me, but it was the most severe time. I ended up limping for several weeks. I since recovered and my knee feels mostly fine most of the time but I still go to see a physiotherapist and I still have to be super careful. I have had to eliminate a lot of seated yoga poses from my life, like any of the padmasana variations, because I just don’t have the external rotation in my hip or the stability in my knee to be able to handle them!

I found learning about sesamoid bones helpful to understand my knee issues, and to understand the importance of finding the support from all your accessory muscles, like your glutes, to allow your kneecap to move in the way that is most functional for it. It’s also interesting because this is a more extreme example that shows just how dynamic your bones are - they naturally grow in response to force, which can be a good thing (aka so many things in your body, like your kneecaps or greater trochanters) but also in unwanted ways (aka your bunions!).

My weird knees.

So… how do you feel about your knees? Do you think that sesamoid bones are as crazy as I do? Let me know!